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Viscount Bridgeman: My Lords, I am grateful to my noble friend Lady Gardner of Parkes for initiating this debate. Perhaps I may say how heart-warming it was to hear the speech made by the noble Baroness, Lady Pitkeathley, regarding her personal experience of the subject of the debate. All noble Lords rejoice in seeing her very firmly in her place.
I shall start on a possibly provocative note, comparing the experience of hospital-acquired infection between the NHS and the private sector. Your Lordships will be aware that the great majority of consultants practising in the private sector have NHS contracts and many will move between establishments in the two sectors in the course of a day. Their experience of the incidence of HAI between the two is truly startling.
I must declare an interest as the chairman of an independent hospital and hospice. I am certainly not here to blow the trumpet for the independent sector. I am too well aware of the interdependence between the two sectors, which is, happily, growing in their different ways. I should mention that the hospital of which I am chairman has a hospice wing which is wholly within the National Health Service.
In the matter of organisation and accountability of staff, the private sector may well enjoy an advantage but I do not wish to discuss that here. My purpose is simply to show, in a visible way, that there is no clinical reason why hospital-acquired infections cannot be reduced to an acceptable level. So, regarding what I am now about to say, the private sector leaves the scene. There are one or two features of the National Health Service in which cost is not a consideration—they have been so well covered.
I next wanted to raise the washing of hands between seeing patients, but I could not improve on the comments of the noble Lord, Lord Turnburg. However, the problem cannot be ignored. If hospital staff have to do the marathon to the end of nightingale ward, as the noble Lord, Lord Hunt, described, they must do it.
The noble Lord, Lord Turnberg, also referred to my next subject, which is the much wider use of pre-admission screening, where swabs will detect many infections upon which action can be taken before they can cause cross-infection complications in hospitals. Noble Lords have referred to the matter of cleanliness in the wards. We are continually hearing stories of this in the media. And I am sure that I am not alone in finding it difficult to see why this—which amounts to a scandal—cannot be addressed. In any industry or profession where the matter of cleanliness is identified, whether in the office or on the shop floor, something is normally done about it and promptly.
In the National Health Service the majority of cleaning work, as the noble Lord, Lord Hunt, said, is now out to contract, with the best-value criteria being dominated mainly by cost, with delivery taking second place. One hears all too frequently of ward sisters wringing their hands in frustration at the lack of cleanliness on their wards. It affronts their own professional standards, but there is nothing that they can do about it because they have no control over the cleaners. If a supervisor can be found, He, or she, is
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likely to say that he has very few hours to clean an impossibly large number of wards, but that that is their contract and they cannot do anything about it.
The problem must be addressed with urgency. The tendering system must be changed so that contractors are made more accountable to the nursing management. I compare that with refuse collection by local authorities, which is also almost universally out to tender. Certainly, in my own borough, a complaint to the council is dealt with promptly and, on the whole, effectively, with apparently close communication between council and contractor. The noble Baroness, Lady Murphy, and the noble Lord, Lord Hunt, have referred to welcome initiatives by individual trusts and I hope that that will become a national trend.
The noble Lord, Lord Hunt, referred to side rooms and single beds, as did the noble Lord, Lord Turnberg. The NHS of the 1980s has received a bad press from the noble Baroness, Lady Murphy. But it is a sad commentary on that period that there was a trend to close side wards and turn them into—wait for it—offices. I am told that there is now a welcome move to reverse that trend and to restore side rooms to their originally intended use.
The matter of over-crowding has also been mentioned. The guideline, as I understand it, is that that there should be one bed's width between each bed. That rule frequently cannot be observed due to pressure for beds. Associated with it is the matter of segregation and more isolation rooms. Best practice is for surgical and medical cases to be kept separate, with ring-fencing of elective surgical beds, But, again, pressure of admission of patients all too frequently means that a medical case has to be slotted into a spare bed in a surgical ward, and it is in the interface between medical and surgical cases that some of the greatest risks of cross-infection occur.
Perhaps I may briefly refer to surveillance. A large amount of data on HAI is being collected, but there appears to be little evidence that it is being analysed and the findings acted upon. The feeling among the specialists involved in this field is that it is only when the findings have been established and published that the real extent of the problem will become known, and I am told that it is likely to be of frightening magnitude. Many of the statistics which result from surveillance appear to be—dare I say?—deliberately withheld. For instance, in the year to March 2004 there were 7,647 bloodstream infections due to the MRSA bug. I am advised that of that figure, an alarmingly large proportion resulted in the death of older patients; but that figure appears to be closely guarded by the department.
Finally, I turn to drug prescriptions. I assure your Lordships that I am not attempting to put myself forward as an expert on this matter. Indeed, I refer directly to the noble Lord, Lord Soulsby, on this. The NHS needs to develop a strategy on rational antibiotic prescribing. It is well known that in the past 40 years the drug companies have made comparatively little out of new antibiotics, a point made by my noble friend Lord Soulsby. Their money comes from lifetime-use drugs,
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such as those for blood pressure, arthritis, diabetes or to treat cholesterol. The result is that very little research is going into new antibiotics and such new drugs that come on to the market tend to be clinically useless after a while, as bugs develop resistance, and they have more adverse side effects for patients. Rational antibiotic prescribing involves the use of simple drugs and moving on to the use of broad-spectrum ones only when the simply ones are not effective. A more exhaustive use of this procedure could well result in a cheaper drugs bill and, significantly in the context of this debate, fewer drug-induced infections.
Baroness Masham of Ilton: My Lords, I thank the noble Baroness, Lady Gardner of Parkes, for again bringing up this very important matter. In February 1996, I brought up the increasing problem of methicillin resistant staphylococcus aureus in an Unstarred Question in your Lordships' House. I saw it then as a growing disaster. We have had two Select Committees in your Lordships' House, which made many sensible and practical recommendations on infections and resistance to antibiotics. MRSA seems to be like the sea when King Canute told it to go back and it did not do so.
Mr Reid, the Secretary of State for Health, has said that the Government are committed to a relentless campaign to control MRSA. The chief nursing officer, Christine Beasley, has been told to make MRSA her top priority. She has said that more than a million NHS staff would get infection control training. That should have happened a long time ago. It is not just nurses who should be being trained but everyone who is in touch with patients. About three years ago, I was a patient at Stoke Mandeville Hospital, having broken both legs. A young man used to come into my room and clean, but he never cleaned under the bed. So I suggested that he did and explained that germs live in dust and that dust gathers under beds if it is not removed. He said that I was the first person who had told him that. It does not matter whether cleaning staff are in-house or are employed by contract agencies. They all need clear guidelines and training on how to clean. As most of the people doing this work come from all parts of the world, it should be seen that they fully understand. The young man I was dealing with came from Puerto Rico.
The noble Lord, Lord Hunt of Kings Health, used to be asked by some of your Lordships how the process of appointing matrons was progressing. A short time ago, I met a matron from Birmingham who was charming but I wondered whether she was the right person for the job. Perhaps, armed with the new cleaning manual, which should have gone to every NHS hospital, she may manage. Can the Minister say what response has there been to the manual? Is it being used throughout the NHS?
A few weeks ago, I attended an open evening at the Harrogate District Hospital, which is having foundation status. It was showing different departments to the public. The microbiology department ran a clean hands campaign. One scrubbed one's hands, came back and
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put some gel on them, and then put them under an ultraviolet light that showed whether your hands were clean. If they passed the test, one was presented with a large foam hand with, "My hands are clean, are yours?" on it. I have such a hand with me.
Earlier this year, my husband was in intensive care at a local hospital for three weeks. I was pleased to see that all visitors washed their hands on entry. It was not so in the other wards. The use of gel is more available now but it should be everywhere, with notices telling people why they should use it. The Secretary of State has said that MRSA bloodstream infection rates are to be halved in our hospitals by 2008. As the number of infections is now very high, this is still alarming to anyone going into hospital as they may become one of the statistics.
Can the Minister tell the House about the wonder paint that wards off infection? I read that, while trying to find a substance to counter mould, a British paint firm accidentally invented a disinfectant that fights MRSA. Manchester-based HMG Paints came up with Byotrol, a non-toxic and odourless liquid that repels any bug that lands on it. It works particularly well against MRSA. I ask the Minister whether this paint is effective and, if so, is it being used in our NHS hospitals?
I am absolutely convinced that the majority of the public wants really clean hospitals. For years, there have been concerns about this. Having read about the Lincoln enhancer—a British invention with a high speed cleaning head and a polisher that saves time—I wondered whether effective new devices coming on to the market are tried out by the NHS Purchasing and Supplies Agency and whether it has an approved list of products. That could save millions, if not billions, of pounds. Clean hospitals not only save lives but they also raise morale.
Can the Minister tell the House what progress is being made in creating detergents laced with viruses that could rid hospitals of superbugs? Because new antibiotics to replace those made obsolete by superbugs take so long to develop, researchers at Strathclyde University are trying a different approach and have targeted a special type of virus, called a bacteriophage, which attacks bacteria only. Bacteriophages are the natural-born killers of the microbe world. They can infect and destroy bacteria only and cannot harm humans. The research team has used solids with special surfaces on which bacteriophages can be fixed and where they can thrive. The genetic material that creates hundreds of copies of the phage eventually bursts open and the phages spill out and infect other bacteria and, it is hoped, kill MRSA. This sounds exciting and interesting and I hope that the Government are interested in this type of research too.
I bring the matter of hospital planning and bed space to the notice of your Lordships. Even Florence Nightingale recognised the need for adequate space between beds to lessen the risk of the spread of infection. Guidance from NHS Estates, which oversees design and planning matters, states that the space between hospital beds should be 3.6 metres—11 feet 8 inches—to reduce the spread of infection. But the new 18-storey University
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College Hospital, which is due to open next year at a cost of almost £422 million, has just 2.7 metres—8 feet 8 inches—between beds. The problem was spotted by an architect when he and other local residents were shown around the hospital this year. After the NHS trust refused to move the beds further apart, he instructed solicitors to take up the case. UCH said that the new building had been agreed and finalised in 2000, two years before the new NHS Estates guidance on bed spacing.
With the rising hospital infection rates and the Government's challenge to bring down the rates, surely they must see that their guidelines are adhered to. Surely the safety of patients should be paramount. If the private finance initiative is not following the Government's guidelines throughout the country when building new hospitals, what are the Government going to do about it?
There are many infections such as E. coli, TB, legionnaires' disease, HIV, salmonella, pseudomonas, enteritis, hepatitis, and so on, which are dangerous to vulnerable patients in hospital, but MRSA is by far the most prevalent. Hospitals are under immense pressure, and infections increase this pressure. Therefore, there must be better hygiene and discipline all round.
Last year, yet again, I broke a leg in two places in your Lordships' House by getting it stuck in a door. As I am classed as a vulnerable patient, it was suggested that I did not have the leg operated on at St Thomas's Hospital because of the risk of MRSA. I was treated at St John and St Elizabeth, the hospital chaired by the noble Viscount, Lord Bridgeman. Because I had a single room in that hospital, I was thankful to avoid MRSA, but it is a serious matter when patients have to dodge MRSA by moving hospital.
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